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RFI # 202:
837 - COB Ex: Error - Amt Paid

Informal
Formal

Submitter

Ryan White

Description

Example 3.A and 3.B in the 837-P Combined IG walks through an example of a provider-to-payer COB example in which 3 transactions are generated. First, an 837 to Payer A, then an 835 from Payer A, then an 837 to Payer B.

I believe there is an error in the 837 to Payer B when attempting to show the amount that Payer A has already paid on the entire claim.

The 835 shows a payment of $39.15 from Payer A. That number is correct and balanced and can be reached in a number of ways. For example:
$40 (Paid on Line 1) +
$15 (Paid on Line 2) +
$21.04 (Paid on Line 3) -
$21.89 (Patient Resp. Claim-Level Adjustment) -
$15 (Patient Resp. Claim-Level Adjustment) =
-------
$39.15